Healthcare Provider Details

I. General information

NPI: 1730549189
Provider Name (Legal Business Name): SHAREN CARIZO WILSON D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHAREN CARIZO KEMP-DUKES DO

II. Dates (important events)

Enumeration Date: 02/28/2016
Last Update Date: 05/04/2022
Certification Date: 05/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 ROCKVILLE PIKE
BETHESDA MD
20889-2722
US

IV. Provider business mailing address

11114 HILLSDALE DR
KENSINGTON MD
20895-1903
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-4000
  • Fax:
Mailing address:
  • Phone: 240-566-6316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: